Public Health a Scourge Spreads Panic

By Michael S. Serrill

In Araguari, Brazil, suspicious customers stopped visiting Evaldo Marques' hairdressing salon when he began to lose weight and complain of suffering from constant diarrhea. Others even shunned the private pool where he swam. When he left town to be tested for AIDS, Araguari police advised him not to come back. He is now severely ill with the disease and living with relatives in Belo Horizonte.

In Genoa, Italy, police refused to touch a sickly young girl wandering aimlessly in a public park until they were provided with gloves. They feared that she was an AIDS victim. She turned out to be a drug addict.

In Hampshire, England, 46 children were kept home from the Scantabout primary school when their parents found out that a fellow pupil was a nine-year-old hemophiliac who had been exposed to the AIDS virus. Officials insisted that the child stay in school, and eventually the parents relented.

Acquired immunodeficiency syndrome--AIDS--which until recently had been receiving the most attention in the U.S., has jumped the Atlantic and the Pacific, and brought with it the same fear and anxiety that continue to bedevil Americans. Indeed, the reactions frequently border on hysteria, adding ostracism and discrimination to the suffering of the world's AIDS victims. Headlines in Europe have proclaimed the disease's spread with dire warnings of a new plague. This has led Professor Carlo de Bac, secretary of the Italian League to Combat Virus Diseases, to complain that journalists are creating "unjustified alarm and panic worthy of the Dark Ages." But there has been at least one positive result of the increased, if distorted, public awareness of the malady: it has galvanized many foreign governments into action, and they are for the first time distributing information on the dangers of the disease. Moreover, most Western countries have in recent months instituted mandatory testing of donated blood, one of the sources of the AIDS infection.

On the face of it, the panic seems out of all proportion to the numbers involved. Compared with the U.S., which now has seen more than 14,000 cases, other countries appear to have a small number of AIDS victims. Among those nations that have issued official statistics, Brazil ranks second, with 483 known sufferers, followed by France (392), Haiti (377), Canada (323), West Germany (300) and Britain (225). Large areas of the globe, including India, China and the Soviet Union, have reported no indigenous cases at all. But the spread of the virus through international travel seems impossible to control, and it is unlikely to spare any country. As has already been seen in the U.S., once the disease takes hold, the number of victims multiplies rapidly. No one knows how many sufferers around the world have died from the disease, although there have been 7,157 deaths in the U.S.

As part of its effort to calm the growing global fear of a disease that is as little understood by the public at large as it is confounding to researchers, the World Health Organization held a two-day meeting in Geneva last month at which one doctor rejected the "tendency to compare AIDS to the great plagues of the Middle Ages." While acknowledging that a cure is years away, the WHO panel was optimistic about the possibility of slowing the spread of AIDS through government and private information programs, particularly those aimed at male homosexuals, the group most at risk. In the U.S., they represent 73% of those identified as having the disease.

The agency's reassurance in the face of public panic is firmly rooted in medical knowledge. There is no evidence that the AIDS virus, designated HTLV- III, is spread by casual contact with either victims or objects they have touched. Sexual intercourse, particularly homosexual, is by far the leading means of transmission. Semen is the primary agent of infection, and the virus can be carried into the bloodstream through sores or other lesions. Prostitutes, as well as homosexuals, are at risk, and research suggests that they also endanger their customers. Other groups in peril are drug users who regularly inject intravenously and share needles and those who receive transfusions of untested blood. Hemophiliacs, who must regularly receive blood-clotting factor, have also been exposed to the AIDS virus in large numbers.

The disease, which weakens the immune system and makes its victims susceptible to rare cancers and infections, is invariably fatal. Recently a team of doctors reported in the journal Science on a new discovery about AIDS: in a minority of cases, the virus directly attacks the spinal cord and brain, causing severe motor dysfunction and dementia.

The means by which AIDS traveled to the U.S. may never be clear, but the disease appears to have originated in central Africa, where today it is reportedly rampant in a band of ten countries from Gabon through Zaire to Tanzania. Dr. Fakhry Assaad of WHO's division of communicable diseases says statistics indicate that the virus was carried to Europe by homosexuals of various nationalities, and from there to the Middle East and Asia. Countries with a small number of cases, like Japan, he says, often first encountered the virus through the transfusion of contaminated blood.

Other suspected agents for the spread of the disease include American military personnel, some of whom frequent gay bars and bathhouses in West Germany and other countries. "Very many Germans keep their hands away from Americans," says the proprietor of a huge gay disco and bar in Frankfurt. Late last week the Defense Department announced a plan to screen all 2.1 million men and women in the U.S. military for infection by the AIDS virus. Those found to be suffering from the disease will receive a second, more complex battery of tests. Those who have only been exposed to the virus will be counseled and treated.

As recently as four years ago, few realized the dangers of multiple homosexual contacts. But today, says Dr. Assaad, "traveling gays arriving in a European or Asian or African city should know enough to avoid contact with unknown partners. The risk of sex with a partner they have never met before cannot be overestimated." The warning might also apply to heterosexual contacts. Last week scientists reported in the Journal of the A.M.A. that 15 out of 41 victims of AIDS or a less serious affliction called AIDS-related complex (ARC) who were surveyed at Walter Reed Army Medical Center had been infected through sexual contact with a partner of the opposite sex. The AIDS virus' incubation period can be as short as six months. But often it lasts five years or more, which means that the disease can be widely spread before those initially infected know they are victims. Thus, behind today's relatively small number of people outside the U.S. identified as having the disease lies a huge reservoir of future cases. Canada's current 323 cases, medical experts say, will swell to between 25,000 and 100,000 by the end of the decade. In Italy, which to date has reported only 85 confirmed AIDS cases, there are fears that ultimately there will be thousands of sufferers. In West Germany, which has 300 cases, the Robert Koch Institute estimates that there are 100,000 carriers of the HTLV-III virus. In countries with large homosexual populations but little AIDS, the agony is just beginning. Japan, for instance, has an estimated 300,000 homosexuals. Only ten AIDS cases have been reported to date, but government officials say they cannot even begin to guess how large the figure will eventually become.

As this time bomb of illness and suffering ticks away, members of high-risk groups, whether or not they have AIDS, are increasingly finding themselves victims of discrimination. In a small village in Bavaria, residents tried to prevent patients at a local drug-treatment center from using the public swimming pool. In Australia, where there have been 52 AIDS deaths, the New South Wales Antidiscrimination Board receives about 80 calls a month concerning the disease; a third are from employers asking if they can fire homosexual employees. In many countries those who have the disease, or have tested positive for the virus' antibodies, have been refused medical and dental care and have even been evicted by landlords.

Some countries, for a variety of reasons, have pointedly refused to issue statistics to the WHO about the spread of AIDS. Among them are all ten of the Central African states, India and the Soviet Union. Three weeks ago a Soviet official asserted that the country was free of AIDS. The disease, wrote Deputy Health Minister Pyotr N. Burgasov in the newspaper Trud, "is connected with sexual decadence, which is tolerated in certain circles in the West but for our society is unnatural." Burgasov's statement is contradicted privately by Soviet doctors who say they have seen or heard of AIDS cases in the Soviet Union.

Where the AIDS threat is acknowledged, governments have begun to take action. Thailand has proposed barring from the country foreigners who have the disease or are revealed by blood tests to be carrying the virus' antibodies. And Bangladesh, where no cases have yet been reported, is contemplating requiring foreigners entering the country to show evidence of a recent blood test for AIDS. Now that many Western countries have instituted mandatory testing of all donated blood, or have made plans to do so, whole categories of potential AIDS victims could be eliminated: hemophiliacs and others who receive blood transfusions. But the blood test is too expensive for many countries to carry out on a large scale. As a result, Brazil has forbidden the sale of all blood in Rio de Janeiro, and 20% of that city's blood banks have closed.

Despite encouragement from the WHO and other groups, the fight against the spread of AIDS is not yet a worldwide effort. In India, for example, where the government insists there have not been any confirmed cases, health officials are at odds over whether to take preventive action. Dr. D.B. Bisht, director- general of Indian government health services, complains that other "high- priority programs will suffer because of pressure to divert funds from them to anti-AIDS programs. We can't afford this, since there is no evidence of AIDS." Dr. I.S. Gilada, secretary of the Indian Health Organization, considers this a head-in-the-sand attitude. "There is no special immunity to AIDS that Asians enjoy," he says. "By the time we diagnose the first case, it would have spread like wildfire." Gilada's view matches that in the world health community: while panic and hysteria are not called for, only a large dose of public education and preventive medicine can slow the rate at which AIDS is spreading around the world.

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With reporting by Robert Kroon/Geneva and John Wright/London, with other bureaus